3/8/24, 4:12 PM Application Form
PASSPORT APPLICATION FORM
Government of INDIA, Ministry of External Affairs
Service Required
Application Reference Number 24-1003256707
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name NARESH KUMAR
Date of Birth (DD/MM/YYYY) 01/07/1993
Validity Required NA
Place of Birth (Village/Town/City) VELLORE
District TIRUPATHUR
State/UT TAMIL NADU
Region/Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
Employment Type PRIVATE
Is either of your parent (in case of minor)/spouse, a
N
government servant?
Educational Qualification 10TH PASS AND ABOVE
Are you eligible for Non-ECR category? Y
Family Details
Father's Name MEIYAPPAN
Mother's Name VANAJA
Present Residential Address Details
Address 1/4, RAJA STREET, ANDIYAPPANUR, TIRUPATHUR, TAMIL NADU
PIN 635702
Police Station KURISILAPET
Mobile/Tel No. 9003711060
E-mail NARESHK0793@GMAIL.COM
Permanent Residential Address
Address 1/4, RAJA STREET, ANDIYAPPANUR, TIRUPATHUR, TAMIL NADU
PIN 635702
Police Station KURISILAPET
Mobile/Tel No. 9003711060
Emergency Contact Details
NANDHINI 1/4, RAJA STREET, ANDIAPPANUR, TIRUPATHUR -
Name and Address
635702
Mobile/Tel No. 8248269536
Other Details
Enclosures
1.Birth certificate issued by the Registrar of Births and Deaths or the Municipal Corporation or any other prescribed authority
whosoever has been empowered under the Registration of Birth and Deaths Act, 1969 to register the birth of a child born in India
2.Aadhaar Card (Address Proof)
Self Declaration
I owe allegiance to the sovereignty, unity & integrity of India, and have not voluntarily acquired citizenship or travel document of any
other country. I have not lost, surrendered or been deprived of the citizenship of India. I have not contravened any of the conditions
relating to the possession and use of an Indian passport.
I affirm that the information and particulars given by me in this form are true and correct. I further state that I am not suppressing any
material information in this regard. I further affirm that the enclosures and documentary proof submitted in support of my application for
an Indian passport are authentic and solely pertain to me and I am fully responsible for the accuracy of the same. I am liable to be
penalized or prosecuted if found otherwise. I am aware that under the Passports Act, 1967 it is a criminal offence to furnish any false
information or to suppress any material information with a view to obtaining passport or travel document.
I have read and understood the contents of the above and by submitting this form certify that all the information submitted by me in the
form is bonafide.
Place TIRUPATHUR
Date 08/03/2024
https://portal2.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction 1/1
